Comorbidities in patients with gout prior to and following diagnosis: case-control study

Kuo, Chang-Fu; Grainge, Matthew J.; Mallen, Christian; Zhang, Weiya; Doherty, Michael

Abstract

OBJECTIVES: To determine the burden of comorbidities in patients with gout at diagnosis and the risk of developing new comorbidities post diagnosis.

METHODS: There were 39 111 patients with incident gout and 39 111 matched controls identified from the UK Clinical Practice Research Data-link. The risk of comorbidity before (ORs) and after the diagnosis of gout (HRs) were estimated, adjusted for age, sex, diagnosis year, body mass index, smoking and alcohol consumption.

RESULTS: Gout was associated with adjusted ORs (95% CIs) of 1.39 (1.34 to 1.45), 1.89 (1.76 to 2.03) and 2.51 (2.19 to 2.86) for the Charlson index of 1-2, 3-4 and >/=5, respectively. Cardiovascular and genitourinary diseases, in addition to hyperlipidaemia, hypothyroidism, anaemia, psoriasis, chronic pulmonary diseases, osteoarthritis and depression, were associated with a higher risk for gout. Gout was also associated with an adjusted HR (95% CI) of 1.41 (1.34 to 1.48) for having a Charlson index >/=1. Median time to first comorbidity was 43 months in cases and 111 months in controls. Risks for incident comorbidity were higher in cardiovascular, genitourinary, metabolic/endocrine and musculoskeletal diseases, in addition to liver diseases, hemiplegia, depression, anaemia and psoriasis in patients with gout. After additionally adjusting for all comorbidities at diagnosis, gout was associated with a HR (95% CI) for all-cause mortality of 1.13 (1.08 to 1.18; p<0.001).

CONCLUSIONS: The majority of patients with gout have worse pre-existing health status at diagnosis and the risk of incident comorbidity continues to rise following diagnosis. The range of associated comorbidities is broader than previously recognised and merits further evaluation.

Citation

Kuo, C.-F., Grainge, M. J., Mallen, C., Zhang, W., & Doherty, M. (2016). Comorbidities in patients with gout prior to and following diagnosis: case-control study. Annals of the Rheumatic Diseases, 75(1), https://doi.org/10.1136/annrheumdis-2014-206410

• Journal Article Type: Article
• Acceptance Date: Oct 26, 2014
• Online Publication Date: Dec 11, 2015
• Publication Date: Jan 1, 2016
• Deposit Date: Apr 19, 2017
• Publicly Available Date: Apr 19, 2017
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 75
• Issue: 1
• DOI: https://doi.org/10.1136/annrheumdis-2014-206410
• Keywords: Aged, Case-control studies, Comorbidity, Databases, Factual, Female, Follow-up studies, Gout/epidemiology, Humans, Male, Middle aged, Retrospective studies, United Kingdom/epidemiology, Cardiovascular disease, Epidemiology, Gout
• Public URL: https://nottingham-repository.worktribe.com/output/767943
• Publisher URL: http://ard.bmj.com/content/75/1/210.info
• Contract Date: Apr 19, 2017